Provider Demographics
NPI:1679717854
Name:WORRELL, MONIQUE DEBERRY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:DEBERRY
Last Name:WORRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ELM AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4001
Mailing Address - Country:US
Mailing Address - Phone:540-345-6781
Mailing Address - Fax:540-344-3578
Practice Address - Street 1:302 2ND ST SW FL 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-1514
Practice Address - Country:US
Practice Address - Phone:540-345-6781
Practice Address - Fax:540-344-3578
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437137734Medicaid